Can lupus be treated without steroids?

Written by Zhang Lin
Rheumatology and Immunology Nephrology
Updated on September 13, 2024
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Hormones are currently the first choice of drugs for treating lupus erythematosus, and there are no other drugs that can replace them temporarily, so we still recommend using hormones for treatment. Hormones can quickly and effectively suppress the immune response, reducing the damage to the patient's body from the inflammatory substances released during the immune response. This kind of immune-suppressive and anti-inflammatory action is a protective therapeutic effect on the body. Although long-term use of large doses of hormones has certain side effects, it can quickly block the development of the disease and alleviate the condition. The function of hormones cannot be replaced by any other drug at present, so, no matter what stage the lupus erythematosus patients are in and regardless of the type of damage, hormones are the first choice of drugs. Hormones have many side effects, therefore, we need to use hormone drugs for treatment rationally and standardized under the guidance of a doctor, and should not take them arbitrarily to avoid serious consequences.

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Written by Zhang Lin
Rheumatology and Immunology Nephrology
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What causes lupus erythematosus?

The cause of lupus erythematosus is not yet very clear. It is generally believed that the disease is caused by a combination of factors including genetics, environment, estrogen levels, and drugs, leading to immune disorder and consequently the onset of this disease. Studies have found that factors directly related to the onset of lupus erythematosus include ultraviolet rays causing apoptosis of epidermal cells, exposure of new antigens becoming autoantigens, and infections; Other possible related factors include drugs such as hydralazine and isoniazid, as well as food dyes, hair dyes, celery, figs, mushrooms, smoked foods, psychological stress, etc.; it may also be related to factors such as tobacco, vinyl chloride, asbestos, and vaccinations.

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Written by Zhang Lin
Rheumatology and Immunology Nephrology
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What are the symptoms of the early stage of lupus erythematosus?

The main symptom in the early stage of lupus is the appearance of a butterfly-shaped rash on the face, with most patients initially exhibiting these rashes, some of which are not butterfly-shaped. The rash can also appear on fingers, palms, and around the nails. Additionally, over 80% of patients experience unexplained fevers, which are irregular and can sometimes reach up to 40 degrees Celsius. Some patients also experience joint pain in the early stages of the disease, mainly starting with pain in larger joints such as the elbows, knees, and ankles. If joint pain is accompanied by fever, rash, and a decrease in white blood cells, it is advisable to promptly visit a hospital for an examination to check for lupus. Some patients may also experience Raynaud's phenomenon and photosensitivity in the early stages of lupus. There are no fixed symptoms in the early stages of lupus; it is mainly important to observe oneself regularly and seek medical attention if feeling unwell.

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Written by Liu Li Ning
Rheumatology
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What does the early rash of lupus look like?

The early characteristic rash of lupus erythematosus is typically a butterfly-shaped rash on the face. Other common presentations include palm and periungual erythema, discoid rash, nodular erythema, and livedo reticularis. If the rash is not notably itchy, it generally indicates lupus erythematosus. If there is significant itching, it may suggest the possibility of an allergic factor active in the disease. After immunosuppression, itchy rashes should be monitored for possible fungal infections. The specific pathogenesis of systemic lupus erythematosus is still unclear. If a patient exhibits the typical butterfly-shaped rash on the face, systemic lupus erythematosus should be highly suspected. Testing for antinuclear antibodies, and specifically for anti-Sm and double-stranded DNA antibodies, which represent a variety of autoantibodies, can diagnose systemic lupus erythematosus.

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Written by Liu Li Ning
Rheumatology
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Can women with lupus erythematosus have sexual intercourse?

Women with lupus can engage in sexual activity. Sexual activity itself does not affect systemic lupus erythematosus, but it is essential to use contraception. It is recommended to use condoms for contraception. The use of contraceptive pills or withdrawal method is generally not recommended. This is because, in case of an unplanned pregnancy, there could be a risk of triggering a flare-up of the disease. Moreover, the risk of miscarriage or embryonic developmental arrest in pregnant women with lupus is much higher than in healthy individuals. If there are plans for pregnancy, it should only be considered after the disease has been stable for more than six months. During pregnancy, it is crucial to follow medical advice strictly regarding medication and to regularly undergo prenatal screening.

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Written by Zhang Lin
Rheumatology and Immunology Nephrology
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Will the rash of lupus fade away?

Patients with lupus often experience recurrent, stubborn skin lesions on their hands or face, and some may even develop ulceration, atrophy, or scarring on top of the existing erythema. Most lupus patients exhibit erythema, centered around the bridge of the nose and appearing on the cheeks. The lesions are disc-like on both sides with generally clear boundaries, either flat or slightly raised, and are categorized as exudative inflammation. Depending on the severity of the inflammation, the erythema can range from light red, bright red to purple-red. In severe cases, localized edema resembling erysipelas may occur, and scaling and hyperpigmentation may appear as the inflammation subsides. Facial rashes generally resolve, and most rashes do not leave marks after resolution. If hyperpigmentation remains after the erythema has resolved, it suggests a good prognosis. However, erythema in other areas, such as acral erythema and reticular cyanosis, may last for varying durations depending on the patient's individual condition.